Pediatric Drug-Resistant TB in China

Transcription

1 Pediatric Drug-Resistant TB in China Shuihua Lu,Tao Li Shanghai Public Health Clinical Center Jan.18,2013

2 A MDR-TB CASE A four and a half years old boy, spent 4 yeas of his life in hospital. His childhood wasn't happy at all, but with pain,drugs and mum's tears. It all begins with the fact that he got MDR-TB. M.Tuberculosis complex was cultured from various sites on his body sputum blood pus from ear puncture fluid of chest wall abscess lymph node aspirate Urine

3 Time Will Heal All Wounds But it is very difficult Jan.2009 Aug.2010 Aug.2011 Dec.2012

4 For many years, TB among children have been relatively neglected. The first WHO report to include estimates of the burden of TB among children cases 64, 000 deaths in 2011

5 The national epidemiological survey of TB infection rates among children (1990&2000) TB infection rates among children 23.4% TB infection rates among children 25%

6 Reporting of New Smear-positive TB cases among Children in China China CDC cases 1996 cases

7 160 Reporting of pediatric TB cases of Beijing Children Hospital cases of children TB 年 1997 年 1998 年 1999 年 2002 年 2003 年 2004 年 2005 年 2006 年

8 Reporting of pediatric TB cases of Shanghai Public Health Clinical Center 400 cases of children TB 年 2007 年 2008 年 2009 年 2010 年 2011 年 2012 年

9 Shanghai Public Health Clinical Center The only one designated hospital of children tuberculosis in Shanghai

10 Figure 1.Source distribution of 211 cases of pediatric tuberculosis admitted to Shanghai Public Health Clinical Center from Jun.2010 to Dec.2011.

11 Challenges in pediatric TB Diagnostic challenges MDR-TB challenges Paucibacillary TB Unable to expectorate sputum No universally applied diagnostic algorithm Diagnosis of extrapulmonary TB requires specialised services Lower culture yields and DST done Treatment in children with MDR-TB remain poorly understood Need longer duration of therapy

12 Retrospective Study Pediatric TB N=211 Confirmed-TB N=169(80%) Cultrue-confirmed N=72(34%) DST done for first-line drugs N=61(29%) Clinical diagnosed-tb N=42(20%) Clinical character Laboratory finding Treatment outcome analysis

13 Clinical Characteristics at Initial Presentation Characteristic No. (%) Age, median months (IQR) 76(2-191) Male sex 43(68.9) Previous treatment episode 1(1.6) The history of tuberculosis close contact CR features ( n =61) 4(6.6) Normal (all had EPTB) 9 (14.8) Hilar lymphadenopathy or airway compression 33(54.1) Lobar/segmental collapse/opacification 6 (9.8) Large pleural effusion 7 (6.4) Cavities 7 (11.5) HIV-infected 1(1.6) Miliary opacification 9 (14.5) enlargement of lymph node 48(78.7) Transimission : High burden of TB backgroud HIV co-infection rate is low, Unlike other studies in Africa Lymphatic system is extensive involved cervical lymph node 4(6.6) deep lympho node 47(77)

14 Clinical Characteristics at Initial Presentation Tuberculosis type *PTB only 21(34.4) **EPTB only 9(14.8) Both PTB and EPTB 31(50.9) Site of TB Pediatric Tuberculosis: From Head to Toe Miliary 9(14.8) Tuberculous meningitis 11(18) Pleural effusion 12(19.7) Peripheral lymph node 12(19.7) Pericardial effusion 1(1.6) Abdominal area(include peritoneum, 4(6.6) liver,spleed,pancreas, intestines) Bone/joint/spine 4(6.6) Urinary system 4(6.6) Pelvic 1(1.6) Ear 1(1.6) Eye 1(1.6) Throat 1(1.6) Skin 1(1.6)

15 Table 1. Drug Susceptibility and Resistance to First-line Drugs Susceptible to all four first-line drugs 41(67.2) 5% 7% Resistance to first-line drugs 21% Any first-line drug 20(32.8) Isoniazid 14(23.0) 67% Rifampin 5(8.3) Ethambutol 4(6.6) Streptomycin 6(9.8) Isoniazid or rifampin (but not both) 12(19.7) Multidrug resistance** 3(4.9) poly-drug resistance susceptibility to all four first-line drugs single-drug resistance MDR Total 61

16 a Variety of Specimen for TB Tests(n=63) pus from ear 1(1.6) cerebrospinal fluid 3(4.8) lymph node aspirates 2(3.2) induced sputum 14(22.2) percutaneous biopsy of pulmonary 1(1.6) Pericardial effusion 1(.6) pleural fluid 8(12.7) Ascites 2(3.2) gastric aspirate 25(39.7) puncture fluid of para vertebral abscess 1(1.6) Bone Marrow 1(1.6) Urine 4(6.3)

17 Good news What can we do? It's a comfort knowning of more than 80% of children with MDR TB have favourate treatment outcome But it is still a challenge. Specimen is the foundation Performed a multicenter, prospective cohort study

18 It is difficult, It is a hard job, but persistence pays off!! Jan.2009 Aug.2010 Aug.2011 Dec.2012

19 Children are the future

20 THANK YOU!